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Primary care physicians are at the forefront of fibromyalgia management, and deservedly so, a pain management expert said at a Meet-the-Experts Program entitled "Case Studies in Fibromyalgia: Connecting the Dots from Diagnosis to Pain Management" held in conjunction with PAINWeek 2008. "That's just as it should be," moderator Kevin L. Zacharoff, MD, an anesthesiologist and pain management consultant in Setauket, New York, noted.

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A "new" automated bolus technique for continuous popliteal block: a prospective, randomized comparison with a continuous infusion technique.

Anesth Analg. 2008 Oct;107(4):1433-7

Authors: Taboada M, Rodríguez J, Bermudez M, Valiño C, Ulloa B, Aneiros F, Gude F, Cortés J, Alvarez J, Atanassoff PG

BACKGROUND: We designed the present, prospective, randomized, double-blind study to compare the administration of an automated intermittent bolus dose with a conventional technique of continuous infusion of local anesthetic for postoperative analgesia in continuous popliteal sciatic nerve blockade. METHODS: Forty-four patients undergoing hallux valgus repair were randomly assigned to receive either a continuous infusion of 0.125% levobupivacaine with an infusion rate of 5 mL/h (continuous infusion group, n=22) or automated bolus doses of 5 mL every hour of the same local anesthetic (automated bolus group, n=22) for 24 h. Postoperative pain scores were assessed using a verbal rating pain score. The amount of rescue tramadol medication for pain was also recorded. RESULTS: In patients of the automated bolus group there was a reduction in pain scores (P<0.05) during the postoperative period, when compared to patients of the continuous infusion group. Five patients in the automated bolus group (24%) and 11 patients of the continuous group (52%) required rescue tramadol analgesia (P=0.055). CONCLUSION: The present investigation demonstrated that local anesthetic administered by an automated bolus technique provided better postoperative pain relief than a continuous infusion technique for continuous popliteal nerve block after foot surgery.

PMID: 18806065 [PubMed - in process]

(Source: Anesthesia and Analgesia)

Pain is more than a symptom of osteoarthritis, it is an inherent and damaging part of the disease itself, according to a study published today in journal Arthritis and Rheumatism. More specifically, the study revealed that pain signals originating in arthritic joints, and the biochemical processing of those signals as they reach the spinal cord, worsen and expand arthritis.

Researchers at the Indiana University School of Medicine seek 200 people with fibromyalgia to determine if motivational reminder telephone calls can prompt patients to exercise more regularly. Fibromyalgia is a disease that causes pain in joints and muscles in about 5 percent of the population. Although not life-threatening, fibromyalgia can have a debilitating effect on a person's quality of life by causing body aches, headaches, stiffness and disrupted sleep.

Chakraborty Susmita, Chakrabarti Jayanta, Bhattacharya DipasriIndian Journal of Pharmacology 2008 40(4):180-182The analgesic effect of the centrally acting opioid, tramadol, is well-known. It has been shown in clinical studies that using tramadol epidurally can provide longer duration of analgesia, without the common side effects of opioids. The study was undertaken to evaluate the duration of analgesia and/or pain free period produced by intrathecal tramadol added to bupivacaine in patients undergoing major gynecological surgery in a randomized double blind placebo controlled protocol. Fifty patients ASA I &amp; II scheduled for Wardmayo's operation and Fothergill's operation were randomly allocated to two equal groups. Group A (n=25) received 3 ml of 0.5% hyperbaric bupivacaine (15 mg) with 0.2 ml of normal saline and Group B (n=25) received 3 ml 0.5% hyperbaric bupivacaine and 0.2 ml (20 mg) tramadol by intrathecal route at L3-4 inter space. Standard monitoring of the vital parameters was done during the study period. Levels of sensory block and sedation score were recorded every two minutes for the first 20 minutes, and then every ten minutes for the rest of the surgical procedure. Assessment of pain was done using Visual Analogue Scale (VAS). The study was concluded when the VAS was more than 40 mm, postoperatively. The patient was medicated and the time was recorded. Duration of analgesia or pain free period was estimated from the time of completion of spinal injection to administration of rescue analgesic or when the VAS score was greater than 40 mm. In Group B patients, the VAS score was significantly lower, as compared to Group A patients. The duration of analgesia was 210 ± 10.12 min in Group A; whereas, in Group B, it was 380 ± 11.82 min, which was found to be significant. (Source: Indian Journal of Pharmacology)

What on earth are we going to do? The stock market is plummeting ~ they just said todays drop of 777.68 is the largest in United States history!!! The credit market is pretty much frozen, companies who keep things going with short term loans are not going to be able to make payroll or keep the lights on!! Is this the beginning of the end, the end of the beginning, or is the this end of life as we knew it? I believe it's the end of life as we have known it. A couple of posts ago I said something about excesses, and that I would love to get rid of most things in my house ~ to live with just the essentials and what holds sentimental value. I hope that is a choice that I have and not something I have to do because of finances.

My personal problems seem little compared to what is going on ~ I was able to get in to see my Doctor today. She did a physical exam and then I had 3 vials of blood drawn. Hopefully, at the worst it will be determined that I have fibromyalgia ~ there are many things way worse. She started me on Ultram (tramadol) it's used for moderate to severe pain. I've taken a dose and so far so good ~ I'm not having a reaction to it!! So far it hasn't helped with the pain ~ maybe by the 2nd dose it will. Since the pain was so severe before I started the new medicine it will probably take a couple of doses.

After I picked up my prescription I went to the floral shop where I work ~ they are so busy. I feel terrible that I have been off, there are 3 funerals plus all the other orders!! I helped to clean some flowers that had just came in ~ I wish I had been able to stay and work the rest of the day. I'm thinking positive that this medicine will work and I can be back tomorrow.